Coverage of TB Services under Social Health Insurance in Indonesia
Indonesia has made great strides in expanding tuberculosis (TB) control over the last few years, with significant assistance from donors, such as the Global Fund. While there are presently substantial external funds for the Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), TB and Malaria health programs, these are likely to diminish greatly over the next few years. The government is developing an exit strategy which aims to eliminate dependency on these grants. Generating revenue from insurance is one of the options for TB sustainability financing. However, there is a need to have a better understanding of the actual and potential for financing TB services through health insurance in Indonesia. To assist with this, we conducted an analysis of national claims data obtained from the public health insurance schemes, and carried out series of interviews with health and insurance managers, and non-Government Organizations (NGOs) in 3 provinces –Aceh, Jakarta, and West Java.
The study provided some interesting results. For example, hospital outpatient TB claims appeared to increase at a much faster rate than PHC-level claims. In addition, the number of inpatient claims appears to be higher than expected based on the national incidence and treatment rates. Issues were identified with the monitoring and evaluation of the TB control program due to fragmentation and lack of coordination among stake holders (district health offices, health providers (especially private sector) and health insurance schemes). Even though most of the health insurance schemes benefit packages are comprehensive for TB services, concerns were expressed about the quality of services including diagnostic tests, drugs, contact tracing and adherence to required standards.
In conclusion, the design of the provider payment mechanism must assist the Ministry of Health (MOH) to meet its TB program goals through the use of the Directly Observed Treatment, Short-course chemotherapy (DOTS) strategy including increasing the demand of patients to seek diagnosis and treatment. A comprehensive approach to the mixed financing and delivery of services will be essential to ensure that TB control is effective.